Provider Demographics
NPI:1598353708
Name:PHOENIX MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:PHOENIX MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESIDERIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-684-6690
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-0659
Mailing Address - Country:US
Mailing Address - Phone:956-227-0720
Mailing Address - Fax:956-338-5750
Practice Address - Street 1:810 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2240
Practice Address - Country:US
Practice Address - Phone:956-227-0720
Practice Address - Fax:956-338-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance